hello every one

Lots of management of pre-term labour or pregnancy complications serum protein electrophoresis crops up in 3 questions contraception counseling diabetics – how to uptitrate meds paeds indigenous health

Some xrays ECGs clinical dermatology photos

Nothing on Medicare PBS Poisoning/toxicology HRT

1.28 weeker with painless pPROM. You are 200km from secondary hospital. 500km from tertiary hospital. What is your management? -Speculum exam, cervix closed, nifedipine, steroids, transfer No speculum exam, send her away Speculum exam, cervix closed, reassure, observe in hospital Other combinations of the above – spec/no spec; keep her/send her

2.A 37 weeker has high BP, protein++++, oedema of legs, how to best prevent seizures? -Magnesium Phenytoin Midazolam PR diazepam

3.Contraception counseling. What’s false about the combined oral contraceptive pill? (rule of 7s) If she starts on day 1-5, she will be covered for pregnancy in 14 days If she misses a pill before the placebos she might need emergency contraception -If she misses a pill close to the end she needs to skip the sugar pills

4.10 months postpartum, a couple don’t want more kids for 3 years. Counseling re: long acting contraception (Nuvaring vs Implanon vs sterilization), which is true? They should have sterilization because they shouldn’t have more kids -If she starts Nuvaring, it is important to exclude pregnancy She will definitely have abnormal bleeding on the Implanon ??

5. and 6. Diabetics – how to uptitrate meds. You have an indigenous health worker who has type 2 DM, hypertension, list of her meds and given her HbA1c and other bloods.

This stem is repeated again with a question about how to engage her in the process of improving her outcomes. suboptimal on 2g metformin, what next

suboptimal on 3g metformin, what next

7.A 2 year old, sick for a day with “a cold”, brought in by his dad, had seizure, looks unwell . Pick one: -IV ceftriaxone IV phenytoin diazepam

8.Indigenous kid with green stuff coming out of his ears, what is it? AOM

-CSOM
OME
OE

18.Indigenous kid with skin sores and puffy face (alluding to PSGN) – which of these would you do to see if he needed to stay overnight in your paeds ward? -BP HR urine dipstick

19.Surfer with exostoses and liquid coming out of ear -Is it otitis externa Furunculosis CSOM AOM

20.Indigenous person with sore knees, murmur (alluding to rheumatic fever), what will help? Rheumatoid factor -ASOT ANA ENA

21.A photo of an excoriated rash behind knees of a 61 year old farmer that got better with steroid cream and a bit better with oral Fluclox prescribed by RFDS. What next? ?-Topical steroids plus mupirocin ointment Topical steroids plus phenergan Topical steroids under occlusion Oral steroids plus fluclox -Emollients plus fluclox

22.55 yr old female had IV injection to treat an arrhythmia. ECG is provided. ECG shows SVT then a pause then resumed at a slower pace, but V4,V5 have ST depression). Which describes the best scenario? -Normal for adenosine Cardioversion has been successful -There is underlying coronary artery disease This woman needs urgent cardiology input This required adrenaline IV

23.45 year old bloke who has diabetes, indigestion while gardening, V2-4 have 1mm ST elevation, T-wave inversion in … , some pain still there after treatment. Which is NOT part of initial management? -Alteplase Enoxaparin Tirofiban Aspirin Morphine

24.24 year old bloke severe forearm pains after mowing the lawn. Past hx of both forearm fractures after going through plate glass at a 21st. What do you think is the MOST IMPORTANT to rule out? -Tendonitis Compartment syndrome Anxiety

8.Photo of ear with a pearly lesion. Is this -chondrodermatitis helicis nodularis BCC SCC

9.74 yr old female with upper abdo pain after meals, weight loss, stress+++ as daughter getting divorced, history of carotid endarterectomy, cholecystectomy, had a normal endoscopy and abdo USS. What is the most likely diagnosis? -Pancreatic cancer Mesenteric ischaemia Helicobacter pylori Anxiety Irritable bowel

10.80 yr old smoker with CXR (shows 2 massive perihilar coin lesions), confused despite IV Abs for pneumonia. What is the aetiology of his confusion?? -Hypercalcemia Hypokalemia Hyponatremia

11.C-spine rules – which is not abnormal?? 2mm lateral displacement Upper anterior soft tissue swelling >0.5x vertebral width above larynx Lower anterior soft tissue swelling >1.3x vertebral width below larynx 5mm between odontoid peg and arches

12.A 21 yr old girl with 2 days of penicillin treatment for tonsillitis now has trismus and foul breath and also uvula displaced. Firstly, what do you do? Ring for ENT advice urgently Start metronidazole Give IV dexamethasone ??

13. A bloke has thoracic pain with weird symptoms, left arm not working well (wasting interossei, decreased strength), loss of vibration to the left knee, right thigh loss of light touch discrimination, upgoing plantars, what is the unifying hypothesis/diagnosis? Arachnoiditis Left mid cervical lesion Right mid cervical lesion Paraneoplastic syndrome Pancoast tumour

14.A lady that had GDM in previous pregnancy wants another pregnancy, what is most important, she weighs 140kg and is on lots of meds that are not Cat A in pregnancy – SSRI, maybe NSAIDS (I can’t remember). What is the most important thing for her to do pre conceiving? HbA1c <7.0 Lose weight Stop meds that are unsafe in pregnancy

15.A girl is on an antipsychotic and antidepressant, is anovulatory, wants to conceive. She needs the antipsychotic and SSRI to feel normal. The stem rambles on non specifically about how the antipsychotic’s side effects are likely to cause the problems, what do you do? Stop antipsychotic Reduce dose of antipsychotic See psychologist Start amisulpride

16.A well 42 year old with paroxysmal AF who successfully terminates bouts with prn meds will take meds for stroke prevention if there is any evidence. What stroke prevention does he need? None Warfarin, INR 2-3 Warfarin, INR 3-4 Clopidogrel 75mg Aspirin 300mg

17.An old dear who moves to your town is on Frusemide 120mg and Digoxin 62.5mcg for heart failure. You realize she needs ACE-I. You start an ACE-I. Creatinine goes from 0.16-0.2. What do you do? Nothing Cut back frusemide Stop the ACE-I

18.Bloke with mania, can drive 500km without stopping, can stay up all night, on amitriptyline and occasional benzos, can’t tolerate sodium valproate, what do you do? Switch from TCA to SSRI Start flunitrazepam Start lithium See a psychologist

19.A male shagged a male in Thailand, super worried about HIV, paranoid people will find out, his wife comes to see you, what do you need to be clear about Can’t talk about other people/patients with her She needs to be accepting of different sexualities Can’t tell her that her husband is homosexual

20.A male nurse shagged a female in Thailand, super worried about HIV, paranoid people will find out Take his bloods yourself labeled with initials and DOB Reassure him that the path lab handles HIV tests in confidential manner

21.23 yr old with 2 y old daughter want to avoid melanoma. What’s your advice? Biopsy has no role

22.While you are seeing your patient for another matter, you spy an abnormal 5mm lesion on them how to do proceed? You are suspicious of melanoma. 3mm punch at edge 3mm punch in the middle Shave biopsy 7mm excision

23.Re: strep pneumonia what’s correct? More case-mortality in ATSI cf non-ATSI 3rd most common cause of bacterial meningitis In children, bacteremia is how invasive pneumococcal disease manifests In adults, bacteremia is how invasive pneumococcal disease manifests

24.Newborn has bilateral undescended testes 15% term babies have them 4-5% of preterm babies have them 30 of preterm babies have them Less likely to be a problem long term if it’s a term baby with undescended testes

25.A bloke has rosacea, a bit of acne, and says he doesn’t drink. What are the truths below about Rosacea? Associated with acne Respond to topical steroids Associated with lupus erythematosis Blepharoconjunctivitis Associated with alcohol

26.Which of the below has robust supportive evidence? NSAIDs for back pain The length of antibiotic treatment for certain URTIs and other infections Shoulder exercises for rotator cuff

27.A bloke who has goats has a high fever and cough. Q fever Leptospirosis Brucellosis Influenza

28.A farmer wants to be vaccinated for Q fever. What do you do? Serology and skin test in the same day Serology Skin test Vaccinate on the spot Vaccinate and again in 5 years

29.24 year old with humeral shaft fracture, mid shaft and not all that angulated. What next? Refer for ORIF Use traction Apply a hanging cast Check for ulna nerve palsy

30.18 month old says da-da only, what do you do? Reassure, see in 2 months Referral to developmental clinic Audiology ??

31.2 year old has been vomiting, had increased abdo sounds, poo with mucus and blood ion it, crying, bringing legs up to stomach but no other findings. What is it? Salmonella gastroenteritis Shigella dysentery Appendicitis Intussusception

32.A 2 year old breastfed toddler has hippy parents who don’t want to vaccinate their child because of concerns about the chemicals in vaccines. Which of the following is true re: additives in vaccines? This compound XXX is unrelated to antifreeze Thimomersal isn’t in any modern vaccines Thimomersal, based on mercury, is only found in miniscule amounts in vaccines

33.What’s the best way to treat AF? (not given information about whether new onset AF or chronic AF or age of patient or comorbidities or whether “best” means least death or best tolerability). Amiodarone Digoxin Flecainide Sotalol (Warfarin was not an answer)

34.An old bloke, heavy smoker, is breathless. FVC is low and FEV/FVC1 is normal. He’s been on amiodarone. What’s wrong? Restrictive lung disease COPD Asthma Lung cancer

35.An indigenous lady, 37 years old, is breathless at rest and during activity. She has palpitations at times. She is intensely focused on your diagnosis (?alluding to thyroid stare?) and anxious. Recent viral infection. Normal BP, HR 140, ECG shows sinus tachy. What’s wrong? Viral cardiomyopathy Rheumatic heart disease Thyrotoxicosis Anxiety

36.LEAST appropriate initial exam for LBBB? CT angiography Thallium scan Angiography Stress ECG Stress echo

37.LEAST helpful for localised back pain over L3 in an old person? Bone scan CT lumbar spine Xray lumbar spine Protein electrophoresis Serum calcium

38.Old man, 80ish, hip pains, has had an increase in hat size, you are shown an excerpt from his xray report of his hip, states “Paget’s, sclerosis and also some osteoarthritis in the hip joint”. Which is least helpful? PSA Calcium Serum protein electrophoresis Creatinine

39.Lady >55 with eyeball pain and forehead headaches, blurry vision, not red, normal slit lamp exam, reactive pupils, 6/18 vision. Which is most appropriate? ESR Intraocular pressure measurement CT scan of the head

40.Picture of red eye at temporal aspect of sclera, normal pupils, decreased VA with some blurriness, what do you do? Steroid drops Reassure Look for underlying high BP and treat Look for underlying diabetes and treat IV ceftriaxone

14 yr old girl who FOOSHes and you see her 4 weeks later, snuffbox tenderness, cast on, then 2 weeks later, why is it still sore after 2 weeks in plaster? Ulnar nerve damage Compartment syndrome Avascular necrosis

3 day old girl “not feeding well” according to her mother, but when you see the neonate, she looks great, is in good condition, SBR 325 (>350 abnormal), management? Regular breastfeeds Septic screen ??

A woman comes to see you after she has had an ectopic pregnancy. Regarding her fertility, which of the following statements below are true? She will have a 3 fold increase in difficulty conceiving Her fertility will be unaffected She will need IVF

Young fit bloke has pericarditis. Which of the following is mostly present and supportive of the diagnosis? Friction rub Saddle ST changes Increased CRP

You are shown an ECG of a young kid. It shows short PR interval, delta waves. What is the diagnosis? WPW ?? ??

You see a young kid after he suddenly fainted. He has a history of falling face down into his dinner a few years ago. What investigation do you do? ECG Drug screen ??

An ATSI fellow has 2 x urine MCS showing sterile pyuria, 200WBC but no growth. Next step? Urine chlamydia testing Cystoscopy

A lady has her UTI treated and repeat urine MCS shows no growth but 200 RBC. What test do you do next? Urine cytology Cystoscopy

A middle aged bloke has his foot operated upon under a spinal anaesthetic. 4 days later, he develops double vision when looking to the right. What’s the most likely cause? Epidural infection Presbyopia 6th nerve palsy

What’s the best way to keep your hands nice and clean? Use soap and water Use alcoholic hand gel Iodine containing cleaning agent 0.75% Chlorhexidine containing agent

Your patient has had hep C for 15 years. He has stable mild elevations in his LFTs. He has moderately elevated cholesterol levels. What is your assessment of this patient? He has mild disease He should be having interferon treatment He needs a biopsy Statins are contraindicated in this case

Which of the following are true? Concussion of a tooth is when it totally falls out Subluxation is when… Extrusive luxation…

What advice do you give to a teenage boy about his knocked out teeth (multiple teeth)? You can use saline to clean it You need to account for missing teeth as they may have been swallowed You should reimplant deciduous teeth

A boy has normal CT and xrays after he injures his back. What is true below? This rules out a spinal cord injury He can still have a spinal cord injury

A bloke’s blood test results are given – high ferritin 500, transferrin saturation is high, what’s the next appropriate step? Liver biopsy Liver ultrasound Genetic test for C282Y/H63D mutations

A young bloke’s dad has haemochromatosis. What’s true? His sister’s chance of getting it is 1in4 because inheritance is x-linked recessive Normal transferrin saturation rule out haemochromatosis If his ferritin is 800 and he doesn’t have the disease he should still be venesected

You want to improve your immunization rates and you have a practice nurse. What do you do? Opportunistic immunizations Practice nurse to coordinate the program Hospital based immunizations

A young lass has lumps on her vulva and it smells. She casually mentions she has this in her armpits. What is it? Hiradenitis suppurativa ??

A middle aged woman has a sore bottom with defaecating. On examination she has a midline 8mm long elliptical ulcer. What’s her treatment? Salbutamol GTN ointment

Crusted yellow lesion on the face, started as a blister, what advice do you give? Antibiotics may be required Remove crusts and apply antiseptic Don’t worry it’s not all that contagious

Which of the following terms indicates a test’s ability to give the same results repeatedly? Sensitivity Accuracy Validity Reliability

A 27 year old yoga teacher has had no antenatal care. What’s the single most important test to do? Her labour is established, obs all normal, things are going well. Group and hold Haemoglobin Urine MCS Group and antibody screen Swabs

A 28 weeker is in established labour after hours at your local hospital. There is no GP obstetrician until the morning. What should the midwife do while waiting for you to arrive? Start IV ceftriaxone Do a CTG Swabs Empty the bladder with a catheter Start nifedipine

An old bloke has osteoporosis. His meds are Alendronate, Calcitriol 2 daily, a PPI, aspirin. He develops reflux. His T-score is -3.0. What do you do? Change to Risendronate Stop aspirin Stop alendronate Increase calcitriol Decrease calcitriol

An asian bloke has granulomas in his liver. What couldn’t it be? Malaria Sarcoidosis Cryptococcus Tuberculosis

Which if the following pathological processes does not cause angina? Coronary artery spasm Hypertension Atherosclerosis Thrombosis Vasculitis

A 90 year old has high protein levels, dementia, she is being flown out, RFDS say to give her 16mg oral Dexamethasone. What’s the most important concern? Drug effect causing delirium Osteoporosis ??

A waitress injures her hand at work. You see her after the injury. Her hand is pale and sweaty and she jumps when you touch it. What’s going on? Complex regional pain syndrome

General question about diverticulosis/diverticulitis

9.restless leg syndrome

10. Swallowing 18 . kids his mother need to speak load Check hearing test 20. James is a 58 year old farmer with multiple skin lesions that require resection. He is concerned about achieving optimal wound healing and asks which technical surgical choice you will use. Which one of the following is the best technique to choose and explanation to give James?

A deep fat suture layer because it generally improves wound healing A small number of thick sutures considering he is active Multiple sutures of fine mono filament to reduce skin scarring Continuous subcuticular sutures because they give the best cosmetic result Braided sutures such as silk because they are more resistant to infection

21. fern test premature laber 22. still high cholesterol , need to add more medication to statin Febrazol Ezetimbe

18 . kids his mother need to speak load Check hearing test